Identifying hypertension-related comorbidities from administrative data: What's the optimal approach?
Identifying hypertension-related comorbidities from administrative data: What's the optimal approach?
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DOI：
10.1177/106286060401900504
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发表时间：
2004-09-01
影响因子：
1.4
通讯作者：
Berlowitz, DR
中科院分区：
文献类型：
--
作者：
Borzecki, AM;Wong, AT;Berlowitz, DR
其目的是确定最佳策略，确定门诊患者与高血压相关的诊断使用退伍军人事务部（VA）行政数据库。我们回顾了1999年来自10个VA站点的1176份门诊病历，将11项与高血压管理相关的诊断作为识别合并症的“金标准”。我们计算了该图表与几种基于管理数据的算法的一致性、敏感性和特异性。使用1999年的数据，需要1个行政诊断，观察到的一致性范围为0.98（房颤）至0.85（高脂血症），kappas通常较高。敏感性从38%（烟草使用）到97%（糖尿病）不等; 11个诊断中有10个的特异性超过91%。需要2年的数据和2个诊断改善了大多数措施，灵敏度降低最小。数据库和图表之间的一致性良好。管理数据在识别所有具有给定诊断的患者的能力方面存在差异，但准确识别那些没有诊断的患者。病例发现的最佳策略需要在2年内进行2次诊断。
The objective was to determine the best strategy for identifying outpatients with hypertension-related diagnoses using Veterans Affairs (VA) administrative databases. We reviewed 1176 outpatient charts from 10 VA sites in 1999, taking the presence of 11 diagnoses relevant to hypertension management as the "gold standard" for identifying the comorbidity. We calculated agreement, sensitivity, and specificity for the chart versus several administrative data-based algorithms. Using 1999 data and requiring 1 administrative diagnosis, observed agreement ranged from 0.98 (atrial fibrillation) to 0.85 (hyperlipidemia), and kappas were generally high. Sensitivity varied from 38% (tobacco use) to 97% (diabetes); specificity exceeded 91% for 10 of 11 diagnoses. Requiring 2 years of data and 2 diagnoses improved most measures, with minimal sensitivity decrease. Agreement between the database and charts was good. Administrative data varied in its ability to identify all patients with a given diagnosis but identified accurately those without. The best strategy for case-finding required 2 diagnoses in a 2-year period.